Abstract During 1960 to 1995, 19 of the 269 casesof arterial injuries in limbs treated developed ischemic contracture (7.06%), in which 14 in the lower limbs and 5 in the upper limbs. In the 19 cases, 3 injured arteries were not treated; 1 had his injured arteries repaired infailure; 5 cases had the concomitant veins injured, and 3 of them had their injured veins ligated in the primary treatment. Only 1 case received fasciotomy in his former treatment in other hospital. Four cases were admitted in our Institute in 14 hours, 8 cases were 34 to 57 hours and 7 were 19 days to 19 months after injury. Seventeen out of the 19 injured ateries and 5 out of the 8 injured vein were repaired. Eight cases received fasciotomy. The follow up ranged from 3months to 28 years (averaged 5 years). Sixteen out of the 17 injured arteries remained patent after repair, and the patency were proved by Bultrasound. The causes of ischemic contracture in these cases were analyzed. It was concluded that in order to prevent the limb from ischemic contracture, it should be emphasized that the accurate diagnosis of the injury of the artery and its concomitant ein be made early, the proper treatment be given to the injured artery and vein,and fasciotomy be done immediately as indicated.
Three cases of common peroneal nerve injuries from sports were reported. All of the three cases were overlooked in their early treatment. The diagnosis was clarified 5 months to 33 years after injury. Because the chance of early repair was lost, they all were treated by tendon transfer with the hope to improve the function of foot. The mechanism of this type of injury and the problems related to the diagnosis and treatment were discussed.
OBJECTIVE: To investigate the relationship between the different defect length of vessels and the options of vascular repair, and to compare the different options of repair because of the longitudinal biomechanical effect. METHODS: A clinical analysis was undertaken to evaluate the major arterial and venous injuries in human extremities repaired by end-to-end anastomoses or venous autograft(177 cases, 185 vessels). Compared the defect length of the same kind of vessels repaired by different options (Student-t test). Evaluated the defect length to repair arterial injuries between by end-to-end anastomoses and by vein graft by means of 95% confidence interval. RESULTS: There was significant difference between the defect length of brachial artery repaired by end-to-end anastomosis and femoral artery and popliteal artery repaired by autogenous vein graft (P lt; 0.01). The upper limit of confidence interval in the defect length of brachial artery, femoral artery and popliteal artery was 3.17 cm, 2.81 cm and 2.44 cm respectively by end-to-end anastomosis by means of 95% confidence interval. The lower limit of confidence interval in the defect length of brachial artery, femoral artery and popliteal artery was 2.82 cm, 2.41 cm and 2.17 cm respectively by vein graft by means of 95% confidence interval. The defect length of brachial artery, femoral artery and popliteal artery repaired by vein graft was linear correlation with the length of graft. CONCLUSION: Because of the longitudinal biomechanical difference of arteries and veins in human extremities, different options of repair are necessary to different arterial injuries.
To observe the change of morphology and neuropeptide in the spinal neurons in order to clarify the functional state after injury of peripheral nerves is especially in the late stage. Sciatic nerves were cut with their proximal segments in the preparation of a model of peripheral nerve injury. Combination of horseradish peroxidase retrograde tracing immunohistochemistry and computer image analysis the changes in the morphometry of the perikarya of ventral horn neurons of the spinal cord, the quantitative changes of substance P (SP). Calcitonin gene-related peptide (CGRP) in dorsal horn and CGRP and choline acetyransferase (CHAT) in ventral horn of the spinal cord were examed. The results showd: (1) At the 3rd week after injury, swollen perikarya of the ventral horn neurons were observed, subseauently the swelling of perikarya was decreased tile the 6th week the neurons recovered to their normal size. At the 12th week the neurons were generally stable in their size, shortening of the dendrites was seen in 27% of the neurons. (2) The dendrites of the neurons progressively contracted till at the 12th week 53% of them were degenerated. The results of the 24th week were similar to the that at the 12th week. (3) CGRP in the ventral horn of the spinal cord was elevated to the highest point after 1 week of injury, that lasting for 4 weeks and 8 weeks later, the lever of CGRP returned to normal. From 20th to 24th week, there was no obvious changes of CHAT in the ventral horn of the spinal cord during observation. (4) SP went to the lowest point in the dorsal horn during 2-6 weeks, then recovered slowly, and beiny normal again after 16 weeks, however, CGRP was changed slightly. The results indicated that although a series of degenerating changes occurred in the neurons of the spinal cord during the late peripheral nerve injury, but the functional activity of the central meurons still was maintained at a certain level.
A controversy still exists in the management of nerve injection injury. The results of different timing of operation and methods in treating this type of nerve injury were analysed in limb s function, neuroelectrophysiology and histology. The results showed that the recovery of the injuried nerve in the group of operation, was considerably better than that in the group without operation. In the group of operation early incision of the epineurium with saline irrigation! was superior to late neurolysis. It was suggested that the early incision with saline irrigation could be used as an emergency management for this type of nerve injury.